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HEALTH PRACTICES and the PALEO DIET Ph.D HEALTH PRACTICES AND THE PALEO DIET Ph.D. Thesis – A. Peters McMaster University – Sociology HEALTH PRACTICES AND THE PALEO DIET: UNDERSTANDING HEALTHY EATING FROM PALEO ADOPTERS’ PERSPECTIVES By: Amanda Peters, B.A., M.A. A Thesis Submitted to the School of Graduate Studies in Partial Fulfilment of the Requirements for the Degree Doctor of Philosophy McMaster University © Copyright by Amanda Peters, October 2018 ii Ph.D. Thesis – A. Peters McMaster University – Sociology McMaster University DOCTOR OF PHILOSOPHY (2018) Hamilton, Ontario (Sociology) TITLE: Health practices and the Paleo Diet: Understanding healthy eating from Paleo adopters’ perspectives AUTHOR: Amanda Peters, B.A. (Wilfrid Laurier University), M.A. (University of Guelph) SUPERVISOR: Dr. James Gillett NUMBER OF PAGES: ix, 245 iii Ph.D. Thesis – A. Peters McMaster University – Sociology Abstract In the context of expanding public concern about the healthfulness of food, this thesis examines how health is understood and taken up in individuals’ everyday activities of eating. Sociological frameworks emphasize the complex relations shaping health practices in context; however, a greater focus on the structured nature of practice has weakened appreciation of the agent. Food scholars investigating choice and constructions of healthy food and eating categories, highlight processes involving meaning, experience, action, and identity, at work in contexts of healthy eating. To better locate the agent of health practices, and to connect a health practices approach to healthy eating scholarship, this study draws on theory and methods from the symbolic interactionist tradition in an analysis of lived experiences of healthy eating. Using ethnographic data, including qualitative interviews with 18 adopters of the Paleo Diet, and analysis techniques from grounded theory, this study aims to add nuance to current sociological understandings of health practices. Findings reveal that subjective understandings of the relationship between food and health evolve through interpretive processes involving meaning. By connecting cultural understandings of health to personal, embodied experiences, adopters achieve multilayered understandings of healthy eating that legitimate and catalyze their commitment to their diet. Facing challenges to achieving a Paleo diet, adopters, as agents, engage in material and symbolic work to create “doable” and “livable” versions of Paleo better aligned with resources, preferences, and understandings. Adopters also construct and work to maintain valued identities surrounding their practice; however, iv Ph.D. Thesis – A. Peters McMaster University – Sociology Paleo identities are spoiled identities, as adopters sought to manage conflicting expectations of what constitutes healthy eating, and impressions of who eats a Paleo diet. This thesis demonstrates how an interactionist perspective that appreciates the processual, subjective, and interactional elements of agents’ situated and contextual practices, can be usefully brought in to investigate and inform understandings of activities affecting health. v Ph.D. Thesis – A. Peters McMaster University – Sociology Acknowledgements I wish to express my utmost gratitude to all those who supported me in completing this dissertation. I would like to thank my supervisor, Dr. James Gillett, and my committee members, Dr. Dorothy Pawluch and Dr. Cathy Risdon, for their insightful feedback and expert advice. They empowered me to complete what at times seemed like an impossible task. I have benefited immensely from their combined wisdom and am deeply grateful. I would also like to thank my study participants for their contribution to this work. It has been my honour to bring their voices to bare on some of the most pressing health concerns of our time. I am also grateful for the countless others who provided their stories and perspectives to this work over the years; they added a depth and texture to this work that I could not have anticipated. While at McMaster, I had the opportunity to work closely with faculty, staff and students with a broad range of interests and expertise. I cannot thank enough the mentors, supervisors, support staff, and friends who so enriched my experience, helped to set me on my professional path, and left me with wonderful memories. Last but never least, I want to thank my family, close friends, and my husband, Tom Hummel, for their constant patience, humour, guidance, and love. Their belief in me kept me moving forward. I am so very grateful to have such wonderful people in my life. Thank you. vi Ph.D. Thesis – A. Peters McMaster University – Sociology Table of Contents Abstract ……………………………………………………………………………. iv Acknowledgements ……………………………………………………………….. vi Chapter 1: Introduction ………………………………………………………...... 1 Healthy eating and social life ………………………………………………….. 3 Case study: The Paleo Diet ……………………………………………………. 7 Organization of the dissertation ……………………………………………….. 9 Chapter 2: Literature Review ……………………………………………………. 12 The public health implications of food and eating …………………………….. 12 Socio-behavioural approaches and food choice …………………………… 13 Making sense of ‘healthy eating’: The sociality of food choice…………….. 16 Conclusion ………………………………………………………………….. 21 Dieting and diets ………………………………………………………………. 21 Healthism and the moral management of risk ……………………………... 22 Social-anthropological perspectives ……………………………………….. 25 Vegetarianism ……………………………………………………………… 27 Healthy eating and everyday life …………………………………………… 32 Conclusion ………………………………………………………………….. 37 The social relations of food and eating practices ……………………………… 38 Class ………………………………………………………………………... 38 Gender ……………………………………………………………………… 42 Race and ethnicity ………………………………………………………….. 45 Conclusion ………………………………………………………………….. 48 Summary ………………………………………………………………………. 48 Chapter 3: Conceptual Framework ……………………………………………. 50 Health as social practice ……………………………………………………….. 50 An interactionist approach to health practice ………………………………….. 58 Meaning ……………………………………………………………………. 59 Self ………………………………………………………………………….. 60 The body ……………………………………………………………………. 63 Identity ……………………………………………………………………… 65 Conclusion …………………………………………………………………….. 66 Chapter 4: Methodology ………………………………………………………… 68 Methodological framework ……………………………………………………. 68 Ethnography ……………………………………………………………….. 68 Grounded Theory …………………………………………………………... 70 Methods …………………………………………………………….………..... 72 Data sources ……………………………………………………………...... 72 Data collection and analysis ……………………………………………….. 76 Conclusion …………………………………………………………………….. 79 Chapter 5: Defining Paleo ………………………………………………………. 81 Understandings of Paleo ………………………………………………………. 82 vii Ph.D. Thesis – A. Peters McMaster University – Sociology Personal ……………………………………………………………………. 88 Complementary …………………………………………………………….. 91 Ethical ……………………………………………………………………… 93 Shifting understandings and the role of experience …………………………… 97 Connecting to and building on the past ………………………….………… 98 Vibrant physicality …………………………………………………………. 101 Conclusion …………………………………………………………………….. 106 Chapter 6: Doing Paleo …………………………………………………………. 109 The costs of eating a Paleo diet ……………………………………………….. 110 Food preparation ……………………………………………………………… 115 Strictness ………………………………………………………………………. 119 Gendered roles ………………………………………………………………… 122 Conclusion …………………………………………………………………….. 129 Chapter 7: Constructing a Paleo Identity ……………………………………… 132 Choosing to “do something” …………………………………………………... 134 “Food is the best line of defense” ………………………………………... 134 “Are you Paleo?” ………………………………………………………… 138 Who I’m not …………………………………………………………………… 142 “It’s the people who want a quick fix…” ………………………………… 143 “I’m not drinking the Kool-Aid” …………………………………………. 145 What is best for me ……………………………………………………………. 148 “If it was a fad, it’d be gone by now” ……………………………………. 149 Food “can heal” ………………………………………………………….. 151 “Ultimately, it’s their choice” ……………………………………………. 153 Conclusion …………………………………………………………………….. 158 Chapter 8: Conclusion ………………………………………………………….. 162 Summary of findings and substantive contributions …………………………... 162 Multilayered understandings of ‘healthy eating’ …………………………. 163 Creating a “doable” and “livable” healthy diet …………………………. 165 Being someone who eats a Paleo diet …………………………………….. 169 Conceptual contribution: A grounded understanding of the health practice of eating………………………………………………………………. 172 Suggestions for future research …….…………………………………………. 177 Implications for health promotion, practitioners and systems ………………… 180 Conclusion …………………………………………………………………….. 185 References ……………………….………………………………………………. 187 Appendix A: What is the Paleo Diet?...…………………………………………. 210 Appendix B: Ethics Certificate …………………………………………………. 227 Appendix C: Recruitment Materials …………………………………………… 228 Poster ………………………………………………………………………….. 228 Brochure ……………………………………………………………………….. 229 Scripts …………………………………………………………………………. 231 viii Ph.D. Thesis – A. Peters McMaster University – Sociology Appendix D: Informed Consent ………………………………………………... 234 Appendix E: Interview Guide ………………………………………………....... 238 Appendix F: Background Survey ………………………………………………. 240 Appendix G: Participant Characteristics ……………………………………… 243 ix Ph.D. Thesis – A. Peters McMaster University – Sociology Chapter 1 Introduction The question of what people do when it comes to their health continues to capture the attention of scholars and practitioners across multiple disciplines. This is because the various activities and circumstances that can impact health unfold in complex and indeterminate
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